white paper Utilizing Regional Health Technology to Increase Efficiency and Improve Clinical Outcomes

H. Joerg Schwarz, MSIS, Global Business Development Director, Agfa Healthcare

The Era of Integrated Care What it Means for Hospitals and other Health Providers Drivers for Integrated Care: Improving Outcomes and Reducing Costs Economic Co-operation and Development (OECD) countries, outpacing the rate of inflation. In the United States, the country with the highest overall expenditures, spending reached about 17.7% of gross domestic product (GDP) in 2009 and has since stabilized. The U.S. healthcare expenditure is significantly higher than that of other OECD countries. For example in the UK, where healthcare expenditures peaked in 2009 at 9.9% of GDP, then fell to 9.4%...

Unfortunately, rising cost does not necessarily correlate with high quality of care or better outcomes. Ever since the initial report on errors in the healthcare systems causing unnecessary deaths and costs1 was published and widely reported, many attempts to build a safer and more effective healthcare delivery system were undertaken. Suboptimal healthcare outcomes can also be considered symptoms of system failure. A good example of this is the level of avoidable healthcare escalations for chronic disease patients. In figure 2 it is evident that the U.S. has significantly higher events per 100,000...

Chronic conditions account for approximately 75% of healthcare direct costs in most developed and developing economies in the world. A small subgroup of chronic conditions: diabetes, congestive heart failure, coronary artery disease, asthma (plus other pulmonary conditions), depression, Alzheimer’s and dementia are responsible for the majority of these costs3. The issue for health budgets is that expenses for people with one chronic condition are twice as great as for those without any chronic conditions. As the number of chronic conditions a patient has rises, their cost rises exponentially....

With the Affordable Care Act of 2010, Medicare in the United States started to transition from fee-for-service payments to bundled payments that provide a fixed amount of reimbursement for one or more providers based on standardized procedures. This model is common in countries like Germany, where payments are normalized on DRG codes. Even before the onset of bundled payments, healthcare organizations began forming care models focused on outcomes and paying for value. In these Accountable Care Organizations (ACO), virtual delivery organizations of hospitals and independent physicians contract...

U�S� data applicable to the rest of the world? OECD data shows that the U.S. has currently the biggest spending problem in healthcare, but the core problems are similar across OECD countries, as is the shift away from the fee-for-service model. While some countries are further ahead, there is still a universal need to re-vamp the IT infrastructure to support integrated care delivery. What does this mean for hospitals and their current business model? In a traditional fee-for-service model, hospitals generate revenue primarily through billed acute care services (in-patient services), and additionally...

As depicted in figure 3, a hospital could prepare itself for the business challenges of integrated care by: a) Expanding the revenue base with preventive care services in the community and outpatient procedures, either by purchasing such service providers or by partnering with them. b) Lower overall costs by in-sourcing low volume services from specialized providers with higher volume. c) Providing new services to patients and their caregivers, including providing patients with the tools to participate more in their own self-care, where this is proven to improve outcomes. As a result of both...

The Patient as the Ultimate Care Provider: A Significant Source of Cost Reduction and Quality Improvement One of the major ways to help reduce costs, improve patient outcomes and quality of life is to prevent the development of chronic disease in the first place and to keep patients adherent to therapy once diagnosed. This can often only be achieved by making a patient and the rest of their circle of care a central part of the healthcare team, not just merely a recipient of care. Achieving this requires major behavioral change by the patient18. Patients are an underutilized resource in the circle of...

A 5-step Evolution Towards IT for Integrated Care Healthcare organizations should think of the process of moving toward fully integrated care as a journey that involves all members of the healthcare ecosystem – providers, payers, clinicians, patients and caregivers. The 5-step process below is a suggested roadmap that will help healthcare organizations prepare for new valuebased payment models. Result Delivery & Medical Image Consolidation Step 1 – Results Delivery and Medical Image Consolidation A good place to start with regional data aggregation for integrated care is results delivery for...

Connecting Hospital EMR with the wider Care Community Result Delivery & Medical Image Consolidation Referral Workflows within a vertical integrated delivery network, to save the considerable cost of redundant images. b) With DICOM, there is an existing standard that allows capture and aggregation of data from multiple modalities into a single vendor neutral archive (VNA). Storing images in a single archive saves costs, as only one infrastructure stack is required to scale, backup, and fail-safe. IHE RAD profiles define web services that utilize conventional DICOM archives (PACS systems) to register...

Referral Workflows Step 2 - Referral Workflows Additional benefits can be achieved with an integrated referral flow across a region, an IDN or coordinated entity. In a scenario where any referring physician can log into a clinical portal and start a referral workflow for a given patient, for example to order a medical image procedure or lab test, the ordering process can be simplified and streamlined. As part of the referral workflow it should also be possible to upload pertinent information, including patient demographics, so that the referral target can re-use as much of the preceding diagnostic...